{"id":5513,"date":"2015-02-05T17:54:00","date_gmt":"2015-02-05T23:54:00","guid":{"rendered":"http:\/\/news.medill.northwestern.edu\/chicago\/?p=5513"},"modified":"2015-03-08T15:45:09","modified_gmt":"2015-03-08T20:45:09","slug":"reducing-emergency-room-visits-among-elderly-patients","status":"publish","type":"post","link":"https:\/\/news.medill.northwestern.edu\/chicago\/reducing-emergency-room-visits-among-elderly-patients\/","title":{"rendered":"Reducing emergency room visits among elderly patients"},"content":{"rendered":"<p>By Jamie Friedlander<\/p>\n<p>Nearly 45 percent of ER visits from nursing home residents on Medicare or Medicaid could have been avoided, according to the <a href=\"http:\/\/innovation.cms.gov\/initiatives\/rahnfr\/\">Centers for Medicare and Medicaid Services<\/a>.<\/p>\n<p>These ER visits ended up \u201caccounting for 314,000 potentially avoidable hospitalizations and $2.6 billion in Medicare expenditures in 2005,\u201d CMS reported as part of an on-going effort to reduce ER visits with more preventative care.<\/p>\n<p>Northwestern Memorial Hospital in Chicago is one of three hospitals across the country working to lower the number of nursing home residents that end up admitted to\u00a0the hospital after an ER visit. The initiative is\u00a0part of <a href=\"https:\/\/www.mededportal.org\/icollaborative\/resource\/993\">GEDI WISE<\/a>,\u00a0 a Health Care Innovation Award funded by CMS, according to Dr. Jill Huded, a geriatric fellow at Northwestern Memorial Hospital.<!--more--><\/p>\n<p>Other hospitals and nursing homes across the country are working to lower the rate of elderly patients admitted into emergency departments overall. They hope to reduce the number of ER visits that occur, thus also lowering the number of hospital admissions that happen from an ER visit.<\/p>\n<p>\u201cThe number of older adults has doubled\u00a0in the last decade presenting to the emergency room,\u201d said Huded. \u201cWhen presenting to the [ER], older patients are more likely to be admitted than their younger counterparts and it\u2019s important to prevent this if possible, because the rates of delirium, cognitive impairment, falls and preventable infections goes up. We\u2019d like to keep them in their environment they were living in previously, if possible.\u201d<\/p>\n<figure id=\"attachment_5529\" aria-describedby=\"caption-attachment-5529\" style=\"width: 300px\" class=\"wp-caption alignright\"><a href=\"http:\/\/news.medill.northwestern.edu\/chicago\/wp-content\/uploads\/sites\/3\/2015\/02\/Jill-headshot.jpg\"><img fetchpriority=\"high\" decoding=\"async\" class=\"size-medium wp-image-5529\" src=\"http:\/\/news.medill.northwestern.edu\/chicago\/wp-content\/uploads\/sites\/3\/2015\/02\/Jill-headshot-300x200.jpg\" alt=\"Dr. Jill Huded, a geriatric fellow at Northwestern Memorial Hospital. \" width=\"300\" height=\"200\" srcset=\"https:\/\/news.medill.northwestern.edu\/chicago\/wp-content\/uploads\/sites\/3\/2015\/02\/Jill-headshot-300x200.jpg 300w, https:\/\/news.medill.northwestern.edu\/chicago\/wp-content\/uploads\/sites\/3\/2015\/02\/Jill-headshot-1024x683.jpg 1024w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><figcaption id=\"caption-attachment-5529\" class=\"wp-caption-text\">Dr. Jill Huded, a geriatric fellow at Northwestern Memorial Hospital. (Northwestern Memorial Hospital)<\/figcaption><\/figure>\n<p>The goal of GEDI WISE is to reduce the number of preventable admissions to the hospital, decrease length of stay and reduce preventable readmissions by providing geriatric-specific care to older patients.<\/p>\n<p>In order to do this, geriatric nurses are stationed at the ER at Northwestern Memorial, where they provide evaluations for patients.\u00a0Then they brainstorm with ER physicians, nurses, social workers and physical therapists to try to make it possible for the elderly patients to go home if they don\u2019t have an urgent medical need.<\/p>\n<p>Potentially preventable emergency room visits can include\u00a0injuries from falls, symptoms of a heart condition or pneumonia.<\/p>\n<p>Hospitals themselves also pose an increased risk of infection for elderly adults.<\/p>\n<p>Dr. June McKoy, a geriatrician at Northwestern University&#8217;s Feinberg School of Medicine, agreed that unnecessary ER visits can be detrimental to this frail older population.<\/p>\n<figure id=\"attachment_5523\" aria-describedby=\"caption-attachment-5523\" style=\"width: 211px\" class=\"wp-caption alignleft\"><a href=\"http:\/\/news.medill.northwestern.edu\/chicago\/wp-content\/uploads\/sites\/3\/2015\/02\/Dr.-McKoy.png\"><img decoding=\"async\" class=\"size-medium wp-image-5523\" src=\"http:\/\/news.medill.northwestern.edu\/chicago\/wp-content\/uploads\/sites\/3\/2015\/02\/Dr.-McKoy-211x300.png\" alt=\"Dr. June McKoy, an academic geriatrician at Northwestern University. McKoy is also the director of geriatric oncology for the Robert H. Lurie comprehensive cancer center. \" width=\"211\" height=\"300\" srcset=\"https:\/\/news.medill.northwestern.edu\/chicago\/wp-content\/uploads\/sites\/3\/2015\/02\/Dr.-McKoy-211x300.png 211w, https:\/\/news.medill.northwestern.edu\/chicago\/wp-content\/uploads\/sites\/3\/2015\/02\/Dr.-McKoy-720x1024.png 720w, https:\/\/news.medill.northwestern.edu\/chicago\/wp-content\/uploads\/sites\/3\/2015\/02\/Dr.-McKoy.png 1241w\" sizes=\"(max-width: 211px) 100vw, 211px\" \/><\/a><figcaption id=\"caption-attachment-5523\" class=\"wp-caption-text\">Dr. June McKoy, an academic geriatrician at Northwestern University. McKoy is also the director of geriatric oncology for the Robert H. Lurie comprehensive cancer center. (Northwestern Memorial Hospital)<\/figcaption><\/figure>\n<p>\u201cChange is really hard on older people,\u201d she said. \u201cIf you\u2019ve got a bunch of older people in the nursing home who might have cognitive decline, and you send them to a new environment where the lights are always on and there are strange people around, they will move from that baseline to getting worse.\u201d<\/p>\n<p>CMS launched an initiative in 2012 to try to lower the number of unnecessary visits that occur in nursing home residents. They partnered with seven organizations across the country in September 2012, including Indiana University, to do so.<\/p>\n<p>Indiana University works with 19 nursing facilities in Central Indiana to try to lower the number of unnecessary hospitalizations. Their project, OPTIMISTIC, strives to reduce the number of ER visits of frail older patients through recognizing medical conditions in patients early, improving communication when transfers to hospitals do need to occur and improving advance care planning for terminally ill patients.<\/p>\n<p>OPTIMISTIC, which just passed its two-year mark (and will run for four years total), deployed specially trained nurses to these 19 nursing facilities to help reduce the number of emergency room visits that occur.<\/p>\n<div id=\"related\">\n<p><strong>GEDI WISE<\/strong><br \/>\nGeriatric Emergency Department Innovations through Workforce, Informatics, and Structural Enhancements<\/p>\n<p><strong>OPTIMISTIC<\/strong><br \/>\nOptimizing Patient Transfers, Impacting Medical Quality and Improving Symptoms: Transforming Institutional Care<\/p>\n<\/div>\n<p>\u201cThere are just so many reasons that unnecessary transfers occur,\u201d said Dr. Kathleen Unroe of Indiana University, author of the\u00a0 <a href=\"http:\/\/www.eurekalert.org\/pub_releases\/2015-01\/iu-onc010815.php\">study<\/a> outlining preliminary data from the first year of OPTIMISTIC implementation.<\/p>\n<p>The preliminary data for the first year at these 19 nursing facilities shows that 29 percent of transfers to emergency rooms were avoidable, which is a step down from the national average.<\/p>\n<p>\u201cMy hope is that there will be value seen in putting these resources in the nursing home and that we will collectively figure out a way to do it over the long-term,\u201d said Unroe. \u201cI think there is an increasing expectation that nursing homes can and should take care of fairly sick and complicated patients and in order to do so, we need appropriate resources.\u201d<\/p>\n<p>Linda Colpron, executive director of Brownsburg Meadows. \u00a0\u2013 one of the 19 Indiana nursing facilities participating in OPTIMISTIC \u2013 said early detection is key.<\/p>\n<figure id=\"attachment_5527\" aria-describedby=\"caption-attachment-5527\" style=\"width: 240px\" class=\"wp-caption alignright\"><a href=\"http:\/\/news.medill.northwestern.edu\/chicago\/wp-content\/uploads\/sites\/3\/2015\/02\/Unroe-2x.jpg\"><img decoding=\"async\" class=\"size-medium wp-image-5527\" src=\"http:\/\/news.medill.northwestern.edu\/chicago\/wp-content\/uploads\/sites\/3\/2015\/02\/Unroe-2x-240x300.jpg\" alt=\"Dr. Kathleen Unroe, a Regenstrief Institute investigator and a scientist at the Indiana University Center for Aging Research.\" width=\"240\" height=\"300\" srcset=\"https:\/\/s3.amazonaws.com\/medill.wordpress.offload\/WP%20Media%20Folder%20-%20medill-reports-chicago\/wp-content\/uploads\/sites\/3\/2015\/02\/Unroe-2x-240x300.jpg 240w, https:\/\/s3.amazonaws.com\/medill.wordpress.offload\/WP%20Media%20Folder%20-%20medill-reports-chicago\/wp-content\/uploads\/sites\/3\/2015\/02\/Unroe-2x.jpg 480w\" sizes=\"(max-width: 240px) 100vw, 240px\" \/><\/a><figcaption id=\"caption-attachment-5527\" class=\"wp-caption-text\">Dr. Kathleen Unroe, a Regenstrief Institute investigator and a scientist at the Indiana University Center for Aging Research. (Regenstrief Institute)<\/figcaption><\/figure>\n<p>\u201cThere\u2019s so much going on in a nurse\u2019s day and the OPTIMISTIC program has really honed us into being proactive and not missing the little signs that somebody might be getting an infection, catching that right away and getting treatment so that they don\u2019t deteriorate and have to go out,\u201d she said.<\/p>\n<p>Rita Gould, an assisted living aid at The Holmstad Retirement Community in Batavia said that most of the time, a fall is what makes a nurse decide to send a resident to the emergency room.<\/p>\n<p>Gould added \u2014 on a personal note \u2014 that her mother-in-law and father-in-law, who have since passed away, didn\u2019t feel as though they were treated fairly at times because of their older age.<\/p>\n<p>\u201cThey definitely felt that because they were getting older, they didn\u2019t quite get the attention or the care that they really would\u2019ve liked,\u201d said Gould.<\/p>\n<p>McKoy said the elderly population is the most underserved medically.<\/p>\n<p>\u201cThis is a graying population,\u201d said McKoy. \u201cAnd the most disparate population on earth is the aged. People don\u2019t see them. They\u2019re there, but people don\u2019t really see them.\u201d<\/p>\n<div id=\"featurecaption\">Photo at top: Hospitals and nursing homes across the country, including Northwestern Memorial Hospital, strive to reduce the number of ER visits and resulting hospital admissions that many elderly patients face unnecessarily. (Jamie Friedlander\/Medill)<\/div>\n","protected":false},"excerpt":{"rendered":"<p>By Jamie Friedlander Nearly 45 percent of ER visits from nursing home residents on Medicare or Medicaid could have been avoided, according to the Centers for Medicare and Medicaid Services. These ER visits ended up \u201caccounting for 314,000 potentially avoidable hospitalizations and $2.6 billion in Medicare expenditures in 2005,\u201d CMS reported as part of an [&hellip;]<\/p>\n","protected":false},"author":34,"featured_media":5522,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[29,243],"tags":[],"class_list":["post-5513","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health-and-science","category-winter-2015"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Reducing emergency room visits among elderly patients - Medill Reports Chicago<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/news.medill.northwestern.edu\/chicago\/reducing-emergency-room-visits-among-elderly-patients\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Reducing emergency room visits among elderly patients - Medill Reports Chicago\" \/>\n<meta property=\"og:description\" content=\"By Jamie Friedlander Nearly 45 percent of ER visits from nursing home residents on Medicare or Medicaid could have been avoided, according to the Centers for Medicare and Medicaid Services. These ER visits ended up \u201caccounting for 314,000 potentially avoidable hospitalizations and $2.6 billion in Medicare expenditures in 2005,\u201d CMS reported as part of an [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/news.medill.northwestern.edu\/chicago\/reducing-emergency-room-visits-among-elderly-patients\/\" \/>\n<meta property=\"og:site_name\" content=\"Medill Reports Chicago\" \/>\n<meta property=\"article:published_time\" content=\"2015-02-05T23:54:00+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2015-03-08T20:45:09+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/s3.amazonaws.com\/medill.wordpress.offload\/WP%20Media%20Folder%20-%20medill-reports-chicago\/wp-content\/uploads\/sites\/3\/2015\/02\/GERIATRIC.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"1280\" \/>\n\t<meta property=\"og:image:height\" content=\"720\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"jamiefriedlander\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"jamiefriedlander\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"5 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/news.medill.northwestern.edu\\\/chicago\\\/reducing-emergency-room-visits-among-elderly-patients\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/news.medill.northwestern.edu\\\/chicago\\\/reducing-emergency-room-visits-among-elderly-patients\\\/\"},\"author\":{\"name\":\"jamiefriedlander\",\"@id\":\"https:\\\/\\\/news.medill.northwestern.edu\\\/chicago\\\/#\\\/schema\\\/person\\\/4b22c4fbb2594a690f1a4a793a74c116\"},\"headline\":\"Reducing emergency room visits among elderly patients\",\"datePublished\":\"2015-02-05T23:54:00+00:00\",\"dateModified\":\"2015-03-08T20:45:09+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/news.medill.northwestern.edu\\\/chicago\\\/reducing-emergency-room-visits-among-elderly-patients\\\/\"},\"wordCount\":1053,\"image\":{\"@id\":\"https:\\\/\\\/news.medill.northwestern.edu\\\/chicago\\\/reducing-emergency-room-visits-among-elderly-patients\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/s3.amazonaws.com\\\/medill.wordpress.offload\\\/WP%20Media%20Folder%20-%20medill-reports-chicago\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2015\\\/02\\\/GERIATRIC.jpg\",\"articleSection\":[\"Health and Science\",\"Winter 2015\"],\"inLanguage\":\"en-US\"},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/news.medill.northwestern.edu\\\/chicago\\\/reducing-emergency-room-visits-among-elderly-patients\\\/\",\"url\":\"https:\\\/\\\/news.medill.northwestern.edu\\\/chicago\\\/reducing-emergency-room-visits-among-elderly-patients\\\/\",\"name\":\"Reducing emergency room visits among elderly patients - 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